Provider Demographics
NPI:1598879165
Name:UPTON, JOE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:THOMAS
Last Name:UPTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1511
Mailing Address - Country:US
Mailing Address - Phone:931-823-5653
Mailing Address - Fax:931-823-5654
Practice Address - Street 1:415 E UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1511
Practice Address - Country:US
Practice Address - Phone:931-823-5653
Practice Address - Fax:931-823-5654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 0027201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9179554OtherTENNCARE/ DORAL